Risk factors for acute kidney injury and mortality in septic patients admitted in clinic emergency room in university hospital

Abstract

Sepsis is the main cause of mortality in patients admitted to the emergency room and in intensive care units (ICU) and it is a well-known risk factor for acute kidney injury (AKI), which occurs in approximately 50% of patients with septic shock. AKI associated with sepsis remains a major challenge in intensive care because of its common occurrence, high costs of treatment, and unacceptably high mortality. There are little data regarding the incidence and outcome of patients with sepsis in the ICU and ER in Brazil and Latin America. Generally, these data include only those patients who had a diagnosis of sepsis during the ICU stay, with few reports of the incidence and outcome of sepsis at admission in the emergency room. Thus, Brazilian studies are needed to show the incidence of AKI associated with sepsis, identify risk factors for the development of this syndrome in septic patients and determine early markers of diagnosis and prognosis of kidney injury. This study aims to assess the incidence and identify the risk factors for AKI associated with sepsis and to compare the outcome of patients who developed septic AKI with those who did not develop AKI and identify risk factors for death in patients admitted to the emergency room. Septic patients admitted to the emergency room will be studied prospectively during the period 1st February 2013 to 31 st August 2014. It will be estimated a population of 250 patients during the study. For each patient, a protocol will be performed with clinical and laboratory data and these data will be obtained by the same researcher, since patients admission to the emergency room until patients outcome (hospital discharge or death). Assessment of renal function will be performed daily by a dosage of serum creatinine and urine output. AKI diagnosis will be performed based on AKIN criteria. Results will be presented using descriptive statistics and different statistical tests will be used according to the study objectives. The occurrence of AKI will be set as the dependent variable and the Chi-Square test will be used for comparing categorical variables and t-test for continuous variables. After multivariate analysis will be performed using a logistic regression model with calculations of the odds ratio (OR) and all independent variables with p<0.20 will be included in the analysis. A similar procedure will be performed from the occurrence of death as the dependent variable. All test results will be discussed hypothesis at a 5% significance level (p <0.05). (AU)